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Biceps Subluxation

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Topic updated on 01/17/16 4:34pm
Introduction
  • Bicep tendon sometimes considered the 5th tendon of the rotator cuff
    • involved in movement such as shoulder flexion, abduction
    • shoulder joint stability
  • Most commonly associated with
    • subscapularis tears
    • coracohumeral ligament tear
    • transverse humeral ligament tear
Anatomy
  • Bicep long head tendon originates off supraglenoid tubercle and superior labrum
  • Transverse humeral ligament stabilizes tendon within the bicepital groove
  • Complete glenohumeral anatomy 
Presentation
  • History
    • anterior shoulder pain and clicking
  • Physical exam of shoulder 
    • palpable click with arm abduction and external rotation as tendon subluxates out of groove
Imaging
  • Ultrasound 
    • can give dynamic test of bicep instability
  • MRI 
    • can show increased T2 signal, and displacement out of the bicipital groove
    • coincides with subscapularis tears
Treatment
  • Nonoperative
    • NSAIDS, PT strengthening, and steroid injections
      • indications
        • initial management
      • technique
        •  direct steroid injection in proximity, but not into tendon
  • Operative
    • arthroscopic vs open surgical tendon repair, groove deepening, or release/tenodesis
      • indications
        • reserved for refractory cases for bicep pathology
      • technique
        • can test instability intra-operatively 
        • repair vs release/tenodesis 

 

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